Rubber bullets used for crowd control can be lethal. That's the conclusion of a study published this week in the medical journal The Lancet by an Israeli surgeon.

Surgeon Michael Krausz became interested in rubber bullets - which have a metal core and are coated with hard rubber to blunt their force - after seeing numerous Palestinians who'd been injured with the bullets during clashes with Israeli police in October 2000.

Dr. Krausz studied 152 people who suffered a total of 201 bullet wounds. Though Mr. Krausz says police are instructed to shoot toward the lower part of the body to avoid major injuries, he writes in The Lancet that more than half the injuries were to the chest, neck and face.

Three of the demonstrators Dr. Krausz treated for rubber bullet wounds died at the Rambam Medical Center in Haifa where he works. "We know that the policemen were instructed to shoot toward the lower part of the body, which means either the rubber bullets are inaccurate or in riots, under pressure, we're not sure the policemen always aimed at the lower part of the body," he said.

Besides possibly being inaccurate, rubber bullets must be fired from a distance of at least 40 meters away, according to Dr. Krausz, or they would inflict even greater injuries.

Recognizing the need for anti-riot measures, Dr. Krausz is calling for the use of something other than rubber bullets. "Such as water, very strong flushes of water, tear gas, other means that may deter the rioters but will not cause permanent injuries," he said.

The only other country to use rubber bullets was England against rioters in Northern Ireland. British forces reportedly stopped the practice in the 1970s.